From youth leagues to the NFL, fall in the United States brings the beginning of football season. American football has been around for centuries and keeping people active since its inception. Not only is it a great source of exercise for kids, it also builds on skills like teamwork which apply both on and off the field. For some young athletes, it’s their ticket to college admission and/or scholarships. However, like many recreational activities, playing football carries risk of injury. In the past decade,, a growing body of research (reported in the New York Times) has been linking football to Chronic Traumatic Encephalopathy, or CTE.

CTE is a brain injury resulting from repeated blows to the head—not just concussive blows, but any “closed-head impact injury.” This means football players may be developing CTE despite showing no signs of brain trauma, like concussions or even headaches. Once CTE progresses to a certain point, symptoms like memory loss, confusion, depression and dementia arise. Notably, these symptoms can begin years after the hits to the head have stopped. And the risk is clear: when Dr. McKee, a neuropathologist and director of the CTE Center at Boston University, examined the brains of 111 deceased NFL players, she found evidence of CTE in 110 of them.

Moreover, CTE does not solely affect professional football players. A Boston University study found that starting tackle football before the age of twelve was associated with emotional and cognitive problems later in life. In response, football league leaders have changed some of the rules for youth leagues, including decreasing the number of players on the field and, in some regions, promoting flag-football (a version with no tackling and much fewer hits to the head).

Given these findings on CTE, some scholars outside the football world have gone so far as to suggest football be outlawed. Of course, this brings up debates about individual autonomy and the right to participate in activities which put health at risk. Dr. Lee Goldstein, another lead CTE researcher at Boston University, told his high school football-playing neighbor: “I know I might not stop you, but I feel like education [about the risks of football is] the most important thing here.” As much as he had hoped his neighbor would stop playing football after learning about CTE, Dr. Goldstein understood that the issue was not so cut-and-dry.

Football is deeply ingrained into some American families. It’s not just a recreational sport: it’s their social world, and it contributes to their livelihoods. The New York Times reports, “Education in America is widely seen as a path to success, but all kids don’t have access to the same paths. The system is girded by property taxes, leaving residents of poorer neighborhoods with underfunded schools.” For kids in these neighborhoods, football can provide an alternative “path to success,” fostering social mobility where public education is failing. Dr. Goldstein just aims to make sure football players and their families are informed participants, but, ultimately, until other structures like America’s public school system are repaired, poorer and minority students may continue to take on football’s risks (even when well-informed).

Football has a distinct hold on American culture, but we should pay attention to the growing research on its potential risks for young adults. We’ve provided an overview of the CTE issue, but we encourage families (especially families who participate in football) to seek additional information on the risks of CTE online or from a physician.